Healthcare Provider Details

I. General information

NPI: 1295558104
Provider Name (Legal Business Name): THERON MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7951 SW 40TH ST STE 206
MIAMI FL
33155-6752
US

IV. Provider business mailing address

7951 SW 40TH ST STE 206
MIAMI FL
33155-6752
US

V. Phone/Fax

Practice location:
  • Phone: 786-693-1191
  • Fax: 786-723-6840
Mailing address:
  • Phone: 786-693-1191
  • Fax: 786-723-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD LINARES SUAREZ
Title or Position: MGR/ADMINISTRATOR
Credential:
Phone: 786-693-1191